Active NPI
Bradley S Cavness, DC
- Chiropractor
- Kennett, MO
National Provider Identifier
1063416691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2004003313
- Practice address
- 1226 Independence Ave
Kennett, MO 63857-1316 - Phone
- (573) 888-9990
- Fax
- (573) 888-9993
- NPI assigned
- Jun 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2004003313 | MO | Primary |
Addresses
Primary practice location
1226 Independence Ave
Kennett, MO 63857-1316
Mailing address
1226 Independence Ave
Kennett, MO 63857-1316
Phone (573) 888-9990
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 191799 | Other | MO | BLUE CROSS BLUE SHIELD |
| 2236748 | Other | MO | FIRST HEALTH NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004003313 | MO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224115200000",
"number": "1063416691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1226 INDEPENDENCE AVE",
"city": "KENNETT",
"state": "MO",
"postal_code": "638571316",
"telephone_number": "573-888-9990",
"fax_number": "573-888-9993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1226 INDEPENDENCE AVE",
"city": "KENNETT",
"state": "MO",
"postal_code": "638571316",
"telephone_number": "573-888-9990",
"fax_number": "573-888-9993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVNESS",
"first_name": "BRADLEY",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-10",
"last_updated": "2008-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "2004003313",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "191799",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH NETWORK",
"identifier": "2236748",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennett, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.